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Background: Breast cancer, one of the most prevalent cancers worldwide, poses a significant health burden, particularly in low- and middle-income countries (LMICs). Despite advances in treatment, breast cancer survivors in LMICs face unique challenges, including post-mastectomy pain syndrome (PMPS). Aim: This systematic review synthesises evidence on PMPS prevalence, characteristics, and management in LMICs. Method: We conducted a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020. We searched PubMed, CENTRAL, Embase, Web of Science, Global Index Medicus, and supplementary grey-literature sources for studies of PMPS conducted in LMICs. Eligible studies were screened in duplicate, data were extracted using a piloted form, and methodological quality was assessed using design-specific Joanna Briggs Institute critical checklists and the Mixed Methods Appraisal Tool for mixed-methods studies. Owing to substantial heterogeneity in study design, findings were synthesised narratively. Results: Findings revealed significant variability in its prevalence. Pain was mostly mild, located in the axilla, chest wall, and ipsilateral arm, neuropathic in nature, and exacerbated by physical exertion. Key risk factors include younger age, obesity, extensive surgical procedures, and adjuvant therapies. Treatment strategies encompass simple analgesics, nerve blocks, sympathetic denervation, and advanced techniques, highlighting a multifaceted approach to managing PMPS effectively. Conclusion: Post-mastectomy pain syndrome remains a complex challenge, requiring ongoing research to refine diagnostics, understand underlying mechanisms, and develop personalised treatments to improve patient outcomes. Contribution: This review synthesises evidence on the prevalence, characteristics, risk factors, and treatment options for PMPS, providing knowledge to guide evidence-based clinical interventions and improve patient outcomes.